We start with a single patient’s story in order to share the excitement of a potentially groundbreaking treatment for bum knees and hips. No implant. No surgery. No lengthy recovery period. Just a harnessing of the body’s innate power to heal. But the hope for such a treatment needs to be balanced with an equal dose of caution: Testimonials are not proof. Stories about miracle cures can easily distort what’s known about the safety and effectiveness of any given procedure.

But while overhyped ads combined with uncritical media coverage are enough to make skeptics dismiss stem cell therapy, the procedure could live up to its promise — eventually. “It’s not here quite yet,” says Dr. Nathan Wei, a board-certified rheumatologist in Frederick, Maryland, who has performed more than 100 stem cell treatments since 2007. “But in the near future, I hope, stem cells may be a replacement for joint replacement surgery.”

The reason for such hope has everything to do with the almost magical properties of stem cells. None of this involves embryonic stem cells, the pluripotent powerhouses that form in days-old human embryos and have the potential to morph into any of the 200-plus kinds of cells in the human body. Instead, the focus is on mesenchymal stem cells (MSCs).

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]]>Five years ago, life changed dramatically for Leonard Narracci. For decades, he taught English five days a week to high school seniors, then clocked in extra hours working weekends and summers at a nearby farm.

A battery of tests confirmed that the then 67-year-old was living with cardiomyopathy, or heart failure—a condition affecting about 5 million Americans—which leaves the heart weakened and unable to pump blood efficiently. One clinical tool used to assess heart function is the ejection fraction—a measurement of how well the heart is pumping. Normal ejection fraction is greater than 50 percent. However, if the heart is damaged, it can be significantly lower.

“I had an ejection fraction of 20,” the former teacher says. “My heart was not pumping enough blood or oxygen. I couldn’t do anything and lived like that for four years.”

Narracci was at a crossroad.

“I was in such a state of depression that I felt life just wasn’t worth living anymore,” he recalls. “I told my wife that I had to find a better way to live—if one even existed.”

The road to recovery began on the Internet, where he discovered that scientists were utilizing adult stem cells to treat heart failure, and that this promising approach was under way close to his Florida home. Moreover, the lead researcher—Zannos Grekos, M.D.—was delivering a seminar in nearby Naples. Narracci eagerly attended the presentation, spoke with former patients, then called that same day to schedule an appointment.

Adult Stem Cells: A Primer

More than a decade ago, Dr. James Thomson, director of regenerative biology at the Morgridge Institute for Research of the University of Wisconsin, derived the first stem cells from human embryos. At the time, scientists said the cells could be induced to turn into any type of tissue in the human body, and the medical world was abuzz with talk of a “human spare-parts kit.” Futurists predicted that repairing hearts and regenerating withered brain regions would be as easy as snapping LEGO bricks into place.

But because the extraction of those cells destroyed the embryos, an ethical and political firestorm arose. Since then, researchers like Dr. Grekos have worked to develop regenerative therapies from adult stem cells harvested from mature human tissue—no embryo required. What’s more, patients can often be treated with their own adult stem cells so there is little danger that their immune systems will reject the cells. If adult stem cells live up to their potential, that vision of snapping new body parts into place might not be so farfetched after all.

There’s a lot of high-profile back-and-forth between proponents of different types of stem cells. But where do various lines of stem cells come from, and what distinguishes them from one another?

Cord blood stem cells. Originally touted as a way to bypass ethical concerns associated with embryonic stem cells, stem cells extracted from babies’ umbilical cords haven’t panned out as researchers hoped. In part, that’s because the cells can’t be used in as many therapies as other types. But cord blood stem cell transplants can be a welcome alternative when doctors can’t find a bone marrow donor match for patients who suffer from leukemia.

Induced pluripotent stem (iPS) cells. Though not naturally occurring stem cells, these cells are proof that time travel is possible—at least in a biological sense. Here, scientists train regular adult cells to behave like stem cells. The recipe: Take a culture of normal adult cells (skin or blood cells, for example) and use a modified virus to insert one of several pluripotency genes that are active in embryonic stem cells, turning the developmental clock back to zero. When these modified adult cells are cultured, they can—like embryonic and adult stem cells—turn into other kinds of tissue, including cardiac cells.

Nonembryonic stem cells (adult stem cells). Our body produces these cells for use in everyday processes—fracture healing, tissue regeneration, and new skin growth. Researchers are finding ways to harvest these cells from patients, multiply them in culture, and use them to induce targeted regrowth of failing body tissues.

It was Leonard Narracci’s hope that research in this area could help his weakened heart.

Renewed Hope

In November 2008, Narracci met Dr. Grekos, associate clinical professor at Nova Southeastern University and director of the cardiology and vascular disease branch at Regenocyte—an independent biotechnology firm exploring the potential of adult stem cells. By treating the patient’s stem cells with specific growth factors that the body already uses, the research team was creating a new cell population “educated” to target the damaged area.

“In the past 10 years, we realized that the body’s stem cells possess the ability to regenerate damaged

The procedure, which is international in scope, takes about one week. “We do the blood draw,” explains Dr. Grekos, who has performed more than 400 of these procedures. Five days after a blood draw, the transplant team reintroduces the stem cells back into the patient’s heart.

In December 2008, Dr. Grekos released findings from a small trial on the potential of adult stem cells in heart failure. “Before treatment, the average ejection fraction in participants was roughly 28 percent,” Dr. Grekos says. “After treatment, ejection fraction reached 40 percent or more. I should add that we have found that patients treated in the early course of their disease fare better.”

Some patients may require additional treatment, but to date, no harmful side effects have been noted.

Quality of life also improved.

“Patients now can walk to the beach, go grocery shopping, and play with grandkids,” Dr. Grekos reports. “We also reduced hospitalization due to congestive heart failure in treated patients by more than 80 percent.”

As with any new radically different approach, reaction from professionals in the field is mixed.

“At first, patients sought us out because they had no other options and nothing to lose,” Dr. Grekos says. “More recently, we’re getting referrals from cardiologists and pulmonologists. It’s becoming more mainstream.”

Because the procedure remains experimental, patients must pay out of pocket for the procedure, which can cost about $64,500—and there’s no guarantee of results.

Delivering on the Promise?

While some specialists talk of adult stem cells as a biological and moral holy grail—able to perform regenerative feats without the ethical baggage that drags down embryonic stem cell research—others disagree. They argue that adult stem cells are less “programmable” than embryonic stem cells, for instance—less conducive to being transformed into a variety of different tissue types.

Scientific results, as always, will tell the story. In the next few years, expect to see large-scale human trials of adult stem cell therapies. Those trials will be the ultimate acid tests, determining whether adult stem cells will go down in history as a failed experiment or as the foundation for a golden age of regenerative medicine.

But Leonard Narracci isn’t waiting for the next few years to tell the tale. For him, the future has already begun.

To learn more about the promise of adult stem cells in treating Crohn’s disease and reconstructive surgeries, as well as Dr. Grekos’ research, visit saturdayeveningpost.com/stemcell..

News Worth Knowing

With so much adult stem cell research under way, it can be tough to keep track of it all. We’ve pinpointed some breakthroughs scientists have achieved—and explained why their research is worth keeping an eye on.

Type 1 Diabetes: Going Insulin-Free

A diagnosis of type 1 diabetes means investing hours each day injecting insulin and monitoring blood sugar levels. In 2009, however, researchers at Northwestern University and Brazil’s University of São Paulo reported successfully using patients’ adult stem cells to stop the body attacking islet cells of the pancreas. “It’s the first intervention that has ever resulted in patients being completely drug-free,” says study co-author Dr. Richard Burt, chief of the division of immunotherapy at Northwestern University’s Feinberg School of Medicine.

To restore pancreatic function, researchers extracted stem cells from each patient’s bone marrow. After treating the patients with radiation to lower immune resistance, technicians injected the reserved stem cells in such a way that they migrated to the bone marrow and reconstructed the immune system, which enabled the ravaged islet tissue to grow once more. On average, treated patients lived without insulin injections for 31 months.

Bones: Mending Tough Breaks

Most people who break a bone assume they’ll be on the mend within weeks. But 10 to 20 percent of fractures never heal. Anna Spagnoli, an endocrinologist at the University of North Carolina and colleagues deviseda novel way to heal these bone fractures: seeding them with adult stem cells. In 2008 Dr. Spagnoli tested the technique in the lab. She removed adult stem cells from mouse bone marrow, modified them so they would express a protein called insulin growth factor 1 (IGF-1), then transplanted them into other mice with fractured leg bones. Adult stem cells were marked with a fluorescence gene, so she could see that the cells migrated directly to the site of the injury to help heal the break. “The stem cells make more new bone and new cartilage,” she says. She hopes the therapy will enter clinical trials within the next one or two years.

]]>Top Medical News Stories of the 2000shttp://www.saturdayeveningpost.com/2009/12/26/health-and-family/medical-update/top-medical-news-decade.html
http://www.saturdayeveningpost.com/2009/12/26/health-and-family/medical-update/top-medical-news-decade.html#commentsSat, 26 Dec 2009 14:00:54 +0000http://www.saturdayeveningpost.com/?p=16465The Post's top seven health features from the first decade of the 21st century.

]]>http://www.saturdayeveningpost.com/2009/12/26/health-and-family/medical-update/top-medical-news-decade.html/feed1Adult Stem Cells: Web Extrahttp://www.saturdayeveningpost.com/2009/12/24/in-the-magazine/health-in-the-magazine/stem-cells.html
http://www.saturdayeveningpost.com/2009/12/24/in-the-magazine/health-in-the-magazine/stem-cells.html#commentsThu, 24 Dec 2009 05:00:55 +0000http://www.saturdayeveningpost.com/?p=16719With so much adult stem cell research underway, it can be tough to keep track of it all. Here are some breakthroughs that are worth keeping an eye on.

Regenocyte—an independent biotechnology firm—is exploring the potential of adult stem cells for cardiovascular and severe lung disease. For more about the experimental process from lead researcher Dr. Zannos Grekos and for patient stories, visit Regenocyte – Adult Stem Cell Therapy or call The Heart and Vascular Institute in Naples, Florida, at 866-216-5710.

News Worth Knowing

With so much adult stem cell research underway, it can be tough to keep track of it all. Here are more breakthroughs that are worth keeping an eye on.

Crohn’s Disease: Resetting the Immune System

For sufferers of Crohn’s disease, everyday life can feel like a never-ending bout of food poisoning. The disease arises when the immune system attacks the stomach and intestines, causing abdominal pain, diarrhea, and vomiting. No cure for the condition has yet been found, but Julian Panes, a gastroenterologist at the Hospital Clinic in Barcelona, Spain, thinks he may have hit on the most effective treatment yet: giving chronic Crohn’s patients an infusion of their own adult stem cells to “reset” their immune systems, ending the body’s misguided efforts to attack the digestive system.

The procedure Dr. Panes uses is a straightforward but grueling one. First, patients receive a round of chemotherapy to depress their immune systems, then blood is drawn to obtain a critical mass of adult stem cells. “We check that there is a sufficient number of cells to complete two procedures, just to make sure we are on the safe side,” Dr. Panes says. “After another round of chemotherapy, we infuse the cells into the patient, and the cells populate the bone marrow.” So far, he adds, the treatment seems to result in quick and effective healing of patients’ damaged digestive tissue. “We already have four patients that have been transplanted for more than a year, and three of them are completely without any symptoms. The disease made them miserable, and now they have a normal life.” Dr. Panes plans to begin large-scale clinical trials of the treatment within the next few years.

Reconstructive Surgery: The Next Level

Jeremy Mao, director of the Tissue Engineering and Regenerative Medicine Laboratory at Columbia University’s College of Dental Medicine, thinks he’ll someday be able to do lasting reconstructions of the breast and skin using soft-tissue implants studded with adult stem cells.

In a 2007 animal study, Dr. Mao demonstrated the viability of his technique. First, he inserted adult stem cells that generate fatty tissue into minuscule channels etched in hydrogel implants. He added a growth factor known to promote the development of blood-vessel tissue. Then he transplanted the hydrogel cylinders into mice. He observed that fatty tissue grew in the region of each cylinder—and that it stayed healthy because networks of blood vessels formed to support the new tissue. “When you put micro-channels in the hydrogel, they become a conduit for the blood vessels,” he says.

If Dr. Mao’s technique works in humans, surgeons may be able to perform successful breast reconstructions without silicone and design facial soft-tissue implants that actually hold their shape. Dr. Mao also thinks his method of engineering tissue with its own blood vessel supply will eventually help researchers who use stem cells to build replacement kidneys and livers. “The work we are doing could be informative for more complex organs.”